Lowering the Bar: Patient or Addict?

For some an ADHD diagnosis is a ticket to ride the stimulant express

Wes Hannon, 30, of Harrisburg, Penn. got a prescription for Adderall when he was 24. Before long, he had moved from the prescription stimulant to illicit methamphetamine.

Six years ago, Wes Hannon went to his doctor's office with general complaints: he was shy, unmotivated, and found it hard to focus.

Hannon, 24 when he visited that doctor, was a clerk at a Family Dollar store in Harrisburg, Pa.

He walked out of the office with a preliminary diagnosis -- adult ADHD -- and a prescription for Adderall (amphetamine and dextroamphetamine).

Easy Street

"It was instant," he said of the drug's effects. "It fixed everything. ... All these problems that had ailed me my whole life were gone. I was focused, energetic, confident."

"It was easy."

But each dose lasted only 4 hours.

And as Hannon's tolerance grew, the effect of the drug lessened.

Hannon quickly ramped up the number of pills he was taking, then how often he was taking them. He soon was taking so much Adderall that his doctor drew criticism from others in his practice. Eventually Hannon's doctor sent him to a psychiatrist for a formal diagnosis.

Hannon met with the psychiatrist every day for a week and mentioned problems that he now says are unremarkable -- that he had a hard time focusing on his work, that he jumped from idea to idea in his head. They weren't lies, but he knew what to say to get his diagnosis.

The stimulants made him feel good, and he wanted to keep feeling good.

In one study, published in 2012, some 22% of adults tested for ADHD were found to have exaggerated their symptoms.

At the end of the week, the psychiatrist said he had adult ADHD.

"For some reason or another, they're way too eager to give this stuff," Hannon said. "They give it out like Skittles."

Burgeoning Population

Hannon is one of an estimated 10 million adults who are said to have adult ADHD, though independent experts question that number and the use of drugs to treat the condition.

Just as prescription painkillers have a profile similar to heroin, many ADHD drugs share qualities with street drugs such as methamphetamine and cocaine. One ADHD drug, Desoxyn, is chemically identical to methamphetamine.

There is little research into whether ADHD drugs lead to illicit drug use. But users say it's a well-known evolution.

Armed with a validated diagnosis, Hannon soon was taking 120 milligrams of Adderall a day, four times his original prescription. Still, the pills didn't last long enough. When the bottle ran empty, he'd buy pills from friends -- for $5 or $10 each.

Then he turned to something stronger, cheaper, and easier to find: street methamphetamine.

Two weeks' worth of Adderall ran about $100; a similar supply of meth could be had for $60. And meth lasted 12 hours to Adderall's 4.

Hannon said he was clearly self-medicating for something, but is not sure he ever had adult ADHD. In any case, he concedes, by this point it wasn't just about fixing his problems. It was a full-on addiction.

"You kind of have no choice if you want to keep the train rolling," he said.

A Familiar Path

Experts say Hannon's transition from prescription drug to cheaper street drug followed a common path -- one similar to that of opioid-to-heroin abuse.

"One starts out with a pharmaceutical and then as the need for more drug to get high develops, the costs and drug availability become prohibitive and the user switches to cheap and readily accessible street drug," said Lewis Nelson, MD, chair of emergency medicine at Robert Wood Johnson Medical School at Rutgers University in New Jersey.

Hannon supplemented his legal prescription with illegal meth for just a few months. Soon he switched to meth exclusively.

For about 18 months, Hannon was on meth almost all the time.

He stayed up for days at a time. He estimated that he slept only 6 days out of the month. He would rarely eat or drink.

"When I felt like an elephant was standing on my chest, then I ate something," he said.

Toward the end, he carried just 140 pounds on his 6-foot-7 frame.

His girlfriend left him. He got in a car accident, punctured a lung, and spent a week in the hospital. He was arrested for marijuana possession. Acquaintances overdosed and died.

One day, he looked around and realized his family had written him off and -- aside from the people he got high with -- he had no friends.

So he stopped.

Recovery and Relapse

For about a month, he had hallucinations and was tired all the time. He was depressed and paranoid. He suffered panic attacks.

He had three relapses, the last in July of 2014. He said he hasn't used since.

These days, Hannon can be found on the website Reddit, where he stays in touch with others on a similar path. When he has bad days, he asks to contact other users who are in recovery, just to talk through it. Other days, he's the one offering advice.

"Hang in there," he wrote to one user who was having trouble quitting. "Keep reminding yourself why you stopped."

At one time, Hannon said, he vowed he would never try methamphetamine. Looking back, he knows why he did.

"I don't think I would have tried meth if Adderall wouldn't have opened up the ... gates," he said.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.